Magazine article Drug Topics

Three-in-One Therapy Targets H. Pylori

Magazine article Drug Topics

Three-in-One Therapy Targets H. Pylori

Article excerpt


Not so long ago, the stomach was thought to be sterile. Due to the low pH associated with hydrochloric acid production, it was felt that microorganisms could never survive.

We now know this is not the case, but it was not easy to change a medical paradigm. In fact, in the mid-1980s, Australian physician Barry Marshall resorted to ingesting the bacterium Helicobacter pylori to illustrate what he had discovered in the laboratory - that H. pylori was often the cause of gastritis and peptic ulcer disease. In 2005, two decades later, Marshall and J. Robin Warren shared the Nobel Prize in Medicine for their discovery of H. pylori.

It is now recognized that nine out of 10 gastric ulcers are caused by H. pylori. The bacteria not only survive the acidic pH of the stomach but penetrate the thick protective layer of gastric mucus and attach to gastric epithelium. The release of cytotoxins and weakening of the gastric mucus layer contribute to tissue damage and inflammation. By producing urease and liberating ammonia, me organism interferes with me normal negative feedback exerted by acid on the gastrinsecreting cells, predisposing to hypergastrinemia, increased acid secretion, and gastric metaplasia. Hyperacidity and H. pylori then work synergistically to produce ulcers. Acid-suppressmg drugs treated ulcers but did not cure them. Lifelong treatment was deemed necessary.

Now, however, antibiotic combinations, given over 10 to 14 days, are used to treat ulcers, leaving only a 10% chance of recurrence. But patient compliance has been a limiting factor in H. pylori eradication, due to the complicated dosing regimens. And bacterial resistance to certain antimicrobials (especially clarithromycin) has been cited, as has the potential for allergic reactions with penicillins.

Axcan Pharma has now harnessed the power of three drugs known to have antimicrobial effects, combining them into a novel formulation. Approved last year and now marketed under the trade name Pylera, the new capsule contains 140 mg bismuth subcitrate potassium, 125 mg metroradazole, and 125 mg tetracycline. It is indicated for use in combination with omeprazole for treating H. pylori infection and duodenal ulcer disease. According to Rosemary Berardi, Pharm. …

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